The Casual Smoker: An Overview

Many public health policies have been implemented in recent years, on both the state and national level, which have promoted a decrease in tobacco use. These policies include smoke-free restaurants and bars, smoke-free zones around federal and state buildings, workplace smoking restrictions, tobacco-free contracts for new employees and the ban of smoking in parks in New York City. Although the overall frequency of tobacco use is decreasing in the United States, the percentage of casual smokers is increasing as high as 50% among some groups.[1] From a clinical standpoint, the casual or occasional smoker may be hard to identify and treat. For example, if a patient only smokes on the weekends when she drinks or has an occasional cigarette to reduce stress, she may respond "No" when asked during an annual visit if she is a smoker.

Casual smokers have the propensity to become heavy to moderate smokers. As a result, it is important that physicians advise and counsel them on the benefits of quitting accordingly. Light smoking fluctuates among subpopulations and is particularly common among adolescents, college students, women, pregnant women and ethnic minorities such as African Americans, Latinos and Asians.[2] Additionally, recent evidence has shown that light smokers can be nicotine dependent.[3]

Health Risks of Casual Smokers

Many casual smokers are influenced by social or sensory motives and don’t believe that they are at an increased personal risk for heart disease or cancer. Research shows that this is not the case. There is evidence that smoking duration is a more powerful contributor to lung cancer than frequency of smoking, and that a long duration of casual smoking carries a significant risk of lung cancer.[4] Smoking as few as 1-4 cigarettes a day is associated with increased risks of lung cancer and dying from ischemic heart disease.[5] An 18-year longitudinal study published in 2000 showed that light smoking increased both total and cardiovascular mortality by 60% compared to that of non-smokers.[6]

These serious health risks should be shared with your patients when you are encouraging them to quit.

Casual Smokers and Quitting

Several studies have been published that suggest that casual smokers want to quit. However, little is known about which interventions will work best for them because of their exclusion from clinical trials. In a 1995 population study, researchers found that, compared to regular smokers, casual smokers were more likely to perceive quitting as not very hard, to not smoke their first cigarette within 30 minutes of waking up and to not have been advised by a physician to quit.[8]

Another study reported that light smokers were more likely than regular smokers to report that they were planning to quit and that encouragement from a healthcare provider would help them do so.[9] Similar findings have been reported among African American casual smokers.[10] In addition, evidence published in a 2010 study showed that encouraging smoking reduction prior to attempting cessation enhances cessation outcomes.[11]